Antimicrobial Utilization Study in a Neurology Setting

Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.

Cálculo de los Días de Terapia Antimicrobiana (DOT) en Cuidados Intensivos Pediátricos: una propuesta de metodología basada en el sistema informático de dispensación de medicamentos

Introducción: El método recomendado para la medición de consumo de antimicrobianos (AMB) en pediatría es el cálculo del indicador Días de Terapia estandarizado por ocupación (DOT-std). Sin embargo, en hospitales que no cuentan con fichas electrónicas, obtener el numerador de los días de terapia (DOT) requiere revisión directa de las indicaciones del paciente, dificultando su aplicabilidad. Objetivos: Validar el sistema de registros electrónicos de dispensación de medicamentos desde farmacia como fuente para el cálculo de DOT y DOT-std en la Unidad de Cuidados Intensivos Pediátrica (UCIP). Materiales y Métodos: Se revisaron las prescripciones de AMB desde la ficha clínica (método manual) y se compararon con los registros de dispensación de AMB a la UCIP (método informático) obtenidos del sistema de medicamentos de farmacia. Se evaluó la concordancia entre los DOT obtenidos mediante el Coeficiente de Correlación Intraclase. Resultados: Los AMB más utilizados fueron vancomicina, meropenem y piperacilina/tazobactam. En 9 de 12 AMB se encontró concordancia significativa entre ambos métodos. Conclusiones: Tras un proceso de validación local, los registros del sistema informático de dispensación de medicamentos desde farmacia podrían utilizarse para el cálculo de DOT en pediatría en hospitales que no cuenten con una ficha electrónica que permita su cálculo directo.

Background: The recommended indicator for measuring antimicrobial (AMB) consumption in pediatric patients is the Days of Therapy indicator (DOT), which is then standardized by hospital occupancy rates (DOT-std). However, in hospitals that do not have electronic health records, obtaining the DOT requires a direct review of each pharmacological indication, which is not feasible in the long term. Aims: To validate electronic records from the pharmacy dispensation system as a source for calculating DOT and estimating DOT-std in a Pediatric Intensive Care Unit (PICU). Methods: AMB prescriptions at the PICU of a university hospital were directly reviewed (manual method) and compared with AMB dispensation records (computer method) obtained from the hospital pharmacy system. The Intraclass Correlation Coefficient was used to evaluate the agreement between the DOT obtained by both methods. Results: The most used AMB were vancomycin, meropenem, and piperacillin/tazobactam. A significant agreement between the DOT obtained by using manual and computer methods was found in 9 of 12 evaluated AMB. Conclusions: After a local validation process, the electronic records of the pharmacy drug dispensation system could be considered a valid source for calculating DOT in PICUs in hospitals where electronic health records with prescription data are not yet available.

Comparison of two analysis methods of opioid consumption sum in medical institutions / 中国药房

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

Evaluation of prescribing pattern based on World Health Organization indicators in Maharashtra during COVID-19 pandemic

Introduction: Community pharmacy (CP) is one of the health care centers that have a key role to play in the current COVID-19 pandemic period. Prescriptions monitoring studies are essential as this helps in understanding the current prescribing pattern adopted by physicians. Furthermore, only few CP-based research studies were noted. This study was conducted with an aim to study prescribing pattern using World Health Organization (WHO) indicators from few community pharmacies in Maharashtra, India, during COVID-19 Pandemic period. Material and Methods: An observational study was conducted and sample comprised of prescriptions collected from different parts of Maharashtra (Mumbai, Pune. and Nashik). One thousand and fifty-six prescriptions were collected and data was collected for a period of 6 months (August 2020–January 2021). The variables of interest in this study were: Number of medications in each prescription, number of prescriptions with generic names, number of antibiotics and injectables in each prescription, number of prescribed drugs from essential drug list (EDL), and defined daily dose (DDD). Results: Out of 3058 drugs prescribed, it was found that average number of drugs per prescription was 2.89 (standard deviation ± 1.37). Only 23 (0.75%) were prescribed by generic name. Antibiotics and injectables were 399 (37.78%) and 29 (2.74%), respectively. Drugs that were prescribed from EDL were only 920 (30.08%). The total class of antimicrobial agents prescribed (Anatomical Therapeutic Chemical group J01) was 13. After calculating DDD, DDD of Azithromycin was found to the highest (81.6 g). Conclusion: Among five WHO indicators, only the percentage of encounters with an injection was in compliance with the WHO recommended value. Further studies are required for better understanding of this area.

A drug utilization study of antihyperglycemic agents in diabetes mellitus cases of a South Indian tertiary care hospital

Background: Polytherapy and comorbidities are a significant component of drug prescriptions in type 2 Diabetes mellitus (T2DM) patients. Irrational prescriptions and increased cost and number of drug therapies in T2DM put a considerable burden on patients as well as health authorities. Drug utilization studies are a very important tool in the evaluation of such prescriptions for logistical planning and medical audit of a health care setup. Aims and Objectives: To determine the drug utilization patterns of Antihyperglycaemic agents in diabetic patients attending medicine outpatient department and to assess average cost per prescription and to assess the economic implication. Materials and Methods: A prospective observational drug audit was carried out between January 2017 to June 2018 to determine drug utilization patterns of antihyperglycemic and other agents in T2DM patients attending medicine outpatient department of Konaseema Institute of Medical Science General Hospital, Amalapuram. The data were assessed using the World Health Organization indicators for drug utilization and analyzed using mean percentage and Chi-square tests. Value of P < 0.05 was taken as significant. Results: Metformin had highest Defined Daily Dose of 0.77 and was the most common drug prescribed both as monotherapy (14%) and in combination therapy with glimepiride (42.5%). Amlodipine (15.5%) was the most common non-diabetic drug prescribed in our patients. Average number of drugs per prescription was 3.05, while average number of antihyperglycemic agents per prescription was 1.81. Average cost per prescription was under rupees 50 in 30% of patients and all drugs were prescribed by their brand names. Conclusion: Metformin should be available in sufficient quantities in health care system for T2DM patients and drugs should be prescribed by generic names to reduce cost of drug treatment.

Evaluation of drug utilisation pattern and cost associated with diabetes mellitusType 2 management in Saudi Arabia

Abstract Diabetic mellitus is an emerging disease in Saudi Arabia. In this regard, a cross-sectional retrospective study was conducted to evaluate drug utilization pattern and the cost associated with non-insulin-dependent diabetes mellitus disease management in Saudi Arabia. Data retrieved from the electronic pharmacy records during the last one year were employed in this study. World Health Organization (WHO) Defined Daily Dose (DDD) method was employed to compute the daily price of each oral hypoglycaemic agent. The American Diabetes Association (ADA) guidelines and protocols were used to evaluate the level of adherence. A total of 17057 patients were enrolled in the study. Out of the 17057 patients enrolled in the study, 60.06 % (10246) were males and the rest females. In monotherapy, biguanides (metformin) were the most recommended and utilised drugs among 5673 patients (33.25%). The most commonly used drug combination was found to be sitagliptin+metformin (1754 units). The cost per unit dose was highest for liraglutide (A10BJ02) 258.32SR (68.79USD), and lowest for metformin (A10BA02) 0.49SR (0.13 USD). Metformin was the choice drug for the diabetes patients; biguanides (metformin) and DPP-4 (sitagliptins) were the most familiar established dose combination employed. Generic drugs should be used in order to reduce overall cost.

Prescribing Trend And Drug Cost Analysis Of Oral Hypoglycemic Agents Using Drug Utilisation Review

@#Drug utilization of oral hypoglycemic agents (OHAs) in a private healthcare setting is useful to examine the prescribing pattern of OHAs, especially the newer fixed dose combination (FDC) products. This study was aimed to evaluate the prescribing pattern of OHAs indicated for Type 2 diabetes mellitus (T2DM), to determine the costs of OHAs prescribed and total cost per prescription in the treatment of T2DM in an outpatient department of a private hospital located in central Malaysia. Retrospective review of electronic medical record (EMR) study design was adopted. Patient’s demographic characteristics, medications prescribed, prescribers’ details and cost per prescription were documented. Defined daily dose (DDD) of OHAs and drug cost were calculated. Research ethics protocol was approved and no personal data was collected. Out of the 396 EMR screened, 135 fulfilled the inclusion criteria and subsequently were analysed. In term of demography, mean age of the sample was 51 years old with 59% were male and ethnicity composition of 71% Malay and 19% Chinese. Metformin and “metformin+dipeptidyl peptidase-4 inhibitor” (DPP-4i) were the most commonly prescribed single-drug and FDC OHA, respectively. Average cost of OHAs and total cost per prescription was less than USD 68 and USD 185, respectively. Meanwhile, FDC covered 28.91% of incidences of prescriptions, but 44.6% of cost and SGTL-2i covered 9% incidences of prescriptions and 16.29% of cost. Prescribing pattern of OHA was appropriate based on patient’s T2DM diagnosis, however, dosage given were not in accordance with WHO DDD.

Study of drug prescription pattern and adverse drug reaction monitoring in patients with hypertension and diabetes visiting outpatient department in a government tertiary care hospital in Maharashtra, India

Background: Drug utilization study is an important tool to study the clinical use of drugs and its impact on healthcare system. DUS in patients with HTN and DM is essential to observe the changing prescribing attitude of physicians with the aim to promote rational use of drugs and to minimize the adverse drug reactions.Methods: A cross sectional observational study was conducted on randomly selected patients attending medicine outpatient department in a tertiary care hospital. Drug prescription sheets of 600 patients were studied for 18 months from January 2016 to June 2017 and the prescribing pattern was analysed using the World Health Organization basic drug indicators.Results: Total 2029 drugs were prescribed to 600 patients that belonged to various classes. The average number of drugs prescribed per encounter was 3.4. Majority (61.5%) drugs were prescribed using generic names. Percentage encounters with the antibiotics and injections were 6.3 and 11.5 per cent respectively. 38% drugs were prescribed from the 20th edition of WHO Model List of Essential Medicines. PDD in the current study was found to be significantly less than WHO DDD in all drugs. All of the prescriptions in the present study conformed to WHO guidelines and majority of them with JNC VIII guidelines.Conclusions: The findings of this study are comparable to those of other studies. However, there is a scope of improvement in areas such as overdosing, prescribing more by generic names instead of brand names and from WHO Model List of Essential Medicines.

Reproductive Toxicity and Biomarker Response to a Daily Dose of Tramadol in Male Albino Rats (Rattus norvegicus)

This study was designed to evaluate the effect of a daily dose of tramadol on selected biomarkers viz: haematological parameters, sperm count, kidney and liver damage in male albino rats. Twenty four wistar rats were divided randomly into two groups: control group and treated groups, the treated group were further divided into four groups and housed in cages. Clean drinking water was served to control (group 1), and 1.6 mg/kg bodyweight of tramadol was administered to group 2 (7 days treatment), group 3 (14 days treatment), group 4 (21 days treatment) and group 5 (21 days treatment +7 days withdrawal) in addition to a daily standard diet for all groups. Treatment of rats with tramadol caused significant decrease (P<0.05) in WBC, platelet and lymph. in group 2, on bicarbonate, AST and protein, it showed significant decrease (P<0.05) in group 3, and it showed significant decrease (P<0.05) in group 5 on Cl-, AST, ALT, bicarbonate, AST, PCV, Hb, RBC, WBC, platelet, lymphocytes and sperm count. The results indicates that tramadol has negative effects on the liver which may induce severe liver damage when used for a prolonged period, the results also shows that tramadol can cause anaemia as seen by the observed negative changes in the blood parameters evaluated. Therefore, administration should be with great caution and from a licensed pharmacist or doctor while self prescription or over the counter administration should be avoided considering the associated adverse effects.

Drug utilization research: a review

Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.

Comparison of Total Daily Doses of 16 Active Components in Three Dosage Forms of Fuzi Lizhongwan / 中国实验方剂学杂志

Objective:To compare the total daily doses of 16 active components in big honeyed pills, concentrated pills and tablets of Fuzi Lizhongwan. Method:Three dosage forms of Fuzi Lizhongwan were prepared according to the process described in the literature. RRLC-QqQ-MS was employed to analyze the contents of 16 active ingredients with mobile phase of 0.1%formic acid aqueous solution-0.1%formic acid acetonitrile solution for gradient elution,the separation was performed on a Accucore RP-MS column(2.1 mm×100 mm, 2.6 μm) with a flow rate of 0.3 mL·min-1 and the column temperature at 30℃, the mass spectrometry condition was electrospray ion source, positive and negative ion switching mode for detection, multi-reaction monitoring mode(MRM) for scanning. The contents of 16 active ingredients were calculated, and the normalization arithmetic method was used for comparing the total daily doses of these active ingredients in three dosage forms of Fuzi Lizhongwan. Result:Processed products of Aconiti Lateralis Radix Praeparata were used as raw powder in preparation process of the three dosage forms, so there was no significant difference in the contents of six alkaloids in the three dosage forms, while the contents of other 10 active ingredients from Zingiberis Rhizoma, Codonopsis Radix, Atractylodis Macrocephalae Rhizoma and Glycyrrhizae Radix et Rhizoma Praeparata cum Melle were significantly higher in big honeyed pills than those in concentrated pills or tablets(PConclusion:The total daily doses of 16 active ingredients in the three dosage forms of Fuzi Lizhongwan are significantly different caused by preparation process, prescription and dosage.

Analysis of the Utilization of Antidepressant Drugs in 11 Hospitals from Zhejiang Province during 2013-2017 / 中国药房

OBJECTIVE： To investigate the application of antidepressants in Zhejiang province and to provide reference for rational drug use in clinic. METHODS： WHO-recommended defined daily dose （DDD） method was used to statistically analyze consumption sum， main types， defined daily dose system （DDDs）， daily drug cost （DDC） and ranking ratio （B/A value， i.e. consumption sum rank/DDDs rank， B/A＜1 means the price of drugs was higher， whereas the price of drugs was lower） of antidepressant drugs in 11 hospitals from Zhejiang province during 2013-2017. RESULTS： The consumption sum of antidepressants was increased year by year in 11 hospitals from Zhejiang during 2013-2017， and increased from 3 235 200 yuan in 2013 to 4 569 100 yuan in 2017； the proportion of consumption sum of antidepressants in total consumption sum of all drugs kept stable， ranging from 0.47％ to 0.50％. The top 5 drugs by consumption sum were fluoxetine， duloxetine， olanzapine and venlafaxine； consumption sum of escitalopram accounted for a larger increase （proportion ration increased from 8th place in 2013 to first place in 2017）. Within 5 years， DDDs of fluoxetine， paroxetine and sertraline took up the first 3 place； DDC of olanzapine， quetiapine and duloxetine took up the first 3 place； the drugs with B/A value＜1 included duloxetine， olanzapine， venlafaxine and quetiapine， etc； the drugs with B/A value＞1 were paroxetine and sertraline. CONCLUSIONS： The use of antidepressant drugs in 11 hospitals from Zhejiang province is rational in structure； selective 5-hydroxytryptamine （5-HT） reuptake inhibitors （SSRI）， selective 5-HT and noradrenaline reuptake inhibitor （SNRI） take up the predominant place. New antidepressant drug escitalopram shows a good clinical prospect.

Performance of clinical pulmonary infection score induces the duration and defined daily doses of antibiotics in patients with bacterial severe pneumonia in intensive care unit / 中华危重病急救医学

Objective To explore the impacts of clinical pulmonary infection score (CPIS) on duration and defined daily doses (DDDs) of antibiotics in patients with bacterial severe pneumonia in intensive care unit (ICU). Methods Patients with severe pneumonia, whose antibiotic usage was prescribed with the guide of CPIS, and admitted to ICU severe respiratory and infectious disease ward of Guizhou Medical University Affiliated Hospital from May 2017 to October 2017 were enrolled as CPIS group. Patients with the first CPIS score > 5 were given antimicrobial therapy, and the score was dynamically evaluated every 2-3 days. If the CPIS score < 5, the score was evaluated again after 2 days. If the score was still < 5, the antimicrobial drugs were discontinued. Patients admitted to the same ward from November 2016 to April 2017 were regarded as controls, of whom the antibiotic usage was completely conducted by the clinical experience of the chief physician. The duration and DDDs of antibiotics were compared between patients in two groups. At the same time, the usage of ventilator and prognostic indicators (the length of ICU stay, ICU mortality) were recorded. Kaplan-Meier survival curve was drawn, and the cumulative survival rates of 28 days, 90 days and 12 months were analyzed and compared between the two groups. Results In our department, 177 and 182 patients were admitted to ICU from November 2016 to April 2017 and from May 2017 to October 2017, respectively, of whom 101 and 65 patients with severe pneumonia were collected respectively during the two stages. There was no significant difference in gender composition, age, underlying diseases, vital signs, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, or peripheral blood routine at admission between the two groups, indicating that the baseline data of the two groups were equally comparable. During the treatment process, there was no significant difference in the duration of mechanical ventilation [hours: 126.0 (69.0, 228.8) vs. 120.0 (72.0, 192.0)], the length of ICU stay [days: 7.0 (5.0, 11.0) vs. 8.0 (5.0, 14.0)], or ICU mortality [18.8% (19/101) vs. 26.2% (17/65)] between the control group and CPIS group (all P >0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference in the cumulative survival rate of 28 days (log-rank test: χ2 = 0.540, P = 0.462), 90 days (log-rank test: χ2 = 0.332, P = 0.564) or 12 months (log-rank test: χ2 = 0.833, P = 0.362). Patients from CPIS guided group, however, had a shorter duration of antibiotics usage (days: 7.54±4.81 vs. 9.88±4.96, P < 0.01), and had a lower DDDs of antibiotics (17.58±13.09 vs. 22.73±18.31, P < 0.05) as compared with those in the control group. Conclusion CPIS-guided therapeutic regimen shortens antibiotic duration and decreases antibiotic DDDs in patients with severe pneumonia in ICU, indicating the values of CPIS in guiding antibiotics usage in these patients.

Study of drug prescription pattern in diarrhoea patients admitted to paediatric ward in a government tertiary care hospital in Maharashtra, India

Background: World Health Organization (WHO) has defined diarrhoea as, ‘the passage of loose stools by an individual, at least thrice a day or more frequently than normal’. It is most commonly caused by intestinal infection, mainly viral. Every year there are about 2 billion cases of diarrhoea worldwide, a second leading cause of mortality in children below the age of 5 years. WHO estimated that antibiotic treatment was necessary in only one in twenty cases of childhood diarrhoea. Yet huge resources are currently spent on anti-diarrhoeal drugs annually, most rendered useless or harmful. This study was proposed to evaluate the utilization pattern of drugs prescribed for diarrhoea in children, in a government tertiary care hospital in Maharashtra.Methods: This cross-sectional observational study was carried out in the paediatric ward of government tertiary care hospital, Maharashtra. All patients of age less than twelve years with diarrhoea admitted to paediatric ward within the study period of January 2015 - June 2016 were included in the study. Patients older than twelve years or admitted with other gastrointestinal diseases or co-mordbid conditions were excluded. Statistical analysis was done using descriptive statistics.Results: Majority of the patients admitted were males and more than half the patient population were in the age group of less than or equal to 3 years. Polypharmacy was found to be present in the prescribing pattern, with average, more than 4 drugs prescribed for diarrhoea treatment, in each prescription. Majority drugs were prescribed using brand names and parenteral route. Use of antibiotics was also found to be inappropriate in majority of the cases.Conclusions: The study highlighted the importance of drug utilisation studies and pointed out inappropriate drug prescribing trends for diarrhoea cases in a tertiary care hospital in Maharashtra.

Analysis of analgesics use trend in ten cancer hospitals in China from 2013 to 2016 / 中国肿瘤临床

Objective:To analyze the utilization of analgesics in ten cancer hospitals in China from 2013 to 2016;to analyze the use sta-tus of analgesics and auxiliary analgesics in Chinese patients with cancer, based on the three-step analgesic ladder principle an-nounced by the WHO and the guidelines of National Comprehensive Cancer Network(NCCN),and to provide data for the rational use of cancer analgesics in clinical practice.Methods:A retrospective analysis method was used to extract data on the use of analgesics and auxiliary analgesics in ten cancer hospitals in China between 2013 and 2016.Subsequently,statistical analyses were conducted on the dosage form of the drugs,the total consumption,the defined daily doses(DDDs),the defined daily cost(DDC),and the drug se-quence ratio(B/A).Results:Between 2013 and 2016,patients using analgesics in China comprised 12.6% of the total number of can-cer patients and the cost of analgesics accounted for 1.5% of the total cost of medication for all patients.The main analgesics used were opioids,which accounted for 90.9% of the cost of analgesics;the other types of analgesics,such as the anticonvulsant drugs, were increased.The major administration routes of analgesics in patients were oral,injectable,and topical routes.The DDD rankings of all types of analgesic treatment drugs were basically stable.The DDD values of fentanyl patches,estazolam,oxycodone oral dosage form,morphine oral dosage form,and indomethacin suppository were among the best.The DDC values for most analgesics did not change much,which reflected that price was stable.The DDC values of 13 analgesics were between 10 and 100.Most of the B/A val-ues of all kinds of analgesics were close to 1,with 17 between 0.5 and 1.5,comprised 58.6% of all types of drugs,which indicated that medication synchronization was good.Conclusions:The clinical applications of analgesics are increasing.In China,the treatment of cancer pain generally follows the three-step analgesic ladder principle announced by the WHO.However,there are also some prob-lems.For instance,the daily average cost of a few drugs was high and the synchronization was poor.Therefore,it is necessary to im-prove the management and regulate the treatment of cancer pain.

Analysis on Antihypertensive Drugs Used in 34 Hospitals of Wuhan City during 2013 and 2015 / 中国药师

Objective:To investigate the current situation and trend of the utilization of antihypertensive drugs in Wuhan city. Methods:The utilization data including varieties,consumption sum and DDDs of antihypertensive drugs in 34 hospitals in Wuhan city from 2013 to 2015 were analyzed.Results:The annual consumption sum of antihypertensive drugs increased year by year,and the val-ue was 20 896.67,23 527.19 and 24 033.44 million yuan, respectively. The calcium-channel blockers (CCB), angiotensin Ⅱ re-ceptor antagonist (ARB),adrenergic receptor blockers and angiotensin converting enzyme inhibitors (ACEIs) ranked the top four in consumption sum of antihypertensive drugs. Their constituent ratio was not changed during 2013 and 2015. The consumption amount and DDDs of new compound preparations increased. Top two drugs in terms of consumption amount and DDDs were amlodipine and le-vamlodipine. Conclusion:CCB,ARB,ACEI,adrenergic receptor blockers and diuretics occupy the predominant places among all the antihypertensive drugs in Wuhan city,which is accordance with the current treatment guideline of antihypertensive drugs.

Impacto del uso racional de antimicrobianos en una clínica de tercer nivel en Colombia / Impact of rational use of antibiotics in a third level clinic in Colombia

Background: The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. Aim: To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. Materials and Methods: Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. Results: Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. Conclusions: The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.

Introducción: El aumento progresivo de la resistencia bacteriana a antimicrobianos amenaza la sobrevida de los pacientes y los costos en salud. Objetivo: Determinar el impacto de un programa para el uso racional de antimicrobianos en resistencia bacteriana y consumo de antimicrobianos en una institución de tercer nivel de atención. Materiales y Métodos: Estudio cuasi experimental realizado en una clínica de tercer nivel de la ciudad de Medellín, donde se comparó en dos períodos de tiempo (pre intervención entre octubre de 2012 y septiembre de 2013 y post intervención entre octubre de 2013 y septiembre de 2014) el consumo y la resistencia a antimicrobianos de las bacterias hospitalarias. Resultados: La adherencia a las guías institucionales para el manejo de la patología infecciosa en el período post intervención fue 82%. Se observó una disminución en el consumo de meropenem, ceftriaxona, colistín, vancomicina, y un incremento en el consumo de imipenem, daptomicina y linezolid. Se observó una disminución significativa en la resistencia de Pseudomonas aeruginosa a los antimicrobianos, incluyendo los carbapenémicos. Se presentó un incremento en la proporción de enterobacteriaceas productoras de BLEE (principalmente Escherichia coli) y resistencia a piperacilina/tazobactam. Conclusiones: La construcción e implementación en las instituciones hospitalarias de una estrategia conformada por guías de manejo de la patología infecciosa, restricción en el uso de antimicrobianos y un sistema de vigilancia y un monitoreo permanente a la formulación de éstos, logra un impacto positivo en disminución del consumo de antimicrobianos y resistencia bacteriana.

Utilization Analysis of Carbapenems in 34 Hospitals of Wuhan Area during 2007-2014 / 中国药师

Objective: To investigate the application and tendency of carbapenems in the hospitals of Wuhan area.Methods: The application of carbapenems in 34 hospitals of Wuhan area during 2007-2014 was analyzed statistically in terms of consumption sum, DDDs, DDC and so on.Results: The total consumption sum of carbapenems increased year by year.Compared with that in 2007, the total consumption sum increased by 4-fold in 2014.The growing rate of total consumption sum of biapenem was the fastest among various varieties.Since 2009, three injections including meropenem, biapenem and imipenem / cilastatin predominated the market of Wuhan area, followed by faropenem with oral administration.The changing trend of DDDs was basically consistent with the total consumption sum.DDC of all the drugs was relatively high and demonstrated decreasing tendency, and that of biapenem decreased most notably, while still ranked the first place.DDC of meropenem and imipenem/cilastatin both exceeded 400 yuan.The price of faropenem fluctuated notably during 2007-2009, while increased by 2-fold in 2009 (453 yuan) and then remained stable.Conclusion: The special rectification measures show positive impact on the selection of antimicrobial agents in Wuhan area.The drug varieties are proper, while the average daily cost is still high.The government should continue to strengthen the management of antibiotics to ensure the rational use of carbapenems.

Analysis of Clinical Features of Alprostadil Lipid-micro Injection from 159 Hospitals of China / 中国药房

OBJECTIVE:To provide evidence for rational use and clinical monitoring of Alprostadil lipid-micro injection (Li-po-PGE1). METHODS:Adult inpatients receiving Lipo-PGE1 from hospital information system(HIS)of 159 hospitals were select-ed as research subject. Based on frequency statistics,population,clinical diagnosis,and average daily dose of Lipo-PGE1 were all studied. RESULTS:A total of 71687 adult inpatients were included,and the male was more than female,mostly aged 61-75. The hospitalization duration was 8-14 d(45.01%),most of patients were recovered(68.20%). Lipo-PGE1 was wildly used in the clin-ic,and was used for 871 kinds of clinical diseases in total;top 3 diseases were cerebral infarction(9.06%),non-insulin dependent diabetes mellitus (8.65%) and chronic ischemic heart disease (8.08%). The average daily dose of different diseases and different hospitals were significantly different,mostly≤12.5μg. CONCLUSIONS:As adjuvant drug,medical institutions and related super-vision departments should formulate reasonable monitoring index and strengthen medication guidance and evaluation of Lipo-PGE1.

Analysis of the Amount of Antibacterial Ophthalmic Preparation and Drug Resistance of Ocular Infection Bacteria in a Hospital during 2013-2016 / 中国药房

OBJECTIVE:To provide reference for suitable selection of antibacterial ophthalmic preparation in the clinic. METHODS:The application of antibacterial ophthalmic preparation in a hospital during Jan. 2013-Dec. 2016 were summarized and analyzed to calculate DDDs. The results of bacterial culture and identification,drug sensitivity test were collected. The correlation of DDDs of antibacterial ophthalmic preparation with resistance rates of bacteria was analyzed by using Pearson test. RESULTS:During 2013-2016,there were 7 categories of antibacterial ophthalmic preparations used in this hospital,involving 10 types. To-tal DDDs showed an upward trend with average annual growth rate of 26.16％. DDDs of Tobramycin (dexamethasone) eye drops were the highest for consecutive 3 years (2013-2015). Gatifloxacin eye drops/eye gel and Ofloxacin eye drops/eye oint-ment ranged 2nd-4th place in the list of DDDs. A total of 26143 ocular specimens were examined,and 21 kinds of bacteria were detected,involving 6221 strains with detection rate of 23.80％. Top 3 bacteria in the list of detection rate were Staphylo-coccus epidermidis (3067 strains),Streptococcus pneumoniae (470 strains) and Staphylococcus aureus (321 strains). Resistance rates of above 3 kinds of bacteria to erythromycin were all higher than 70％,while they were sensitive to rifampicin,chlorampheni-col,gentamicin and levofloxacin,etc. Compared to previous year,the average resistance rates of rifampicin(in 2015),gentamicin (in 2015,2016),tetracycline(in 2015),ofloxacin(in 2014,2015),levofloxacin(in 2016)and gatifloxacin(in 2016)had statisti-cally significant differences(P0.05). CONCLUSIONS:The main ocular infec-tions were S. epidermidis,S. pneumoniae and S. aureus. DDDs of tetracycline is certainly associated with resistant rates. Regulating clinical use of antibacterial ophthalmic preparation is important for delaying the development of bacterial resistance.